For those rightly concerned about under-vaccination, mandatory vaccination of schoolchildren is appealing. However, it remains controversial, even for some who know the benefit of vaccination. For instance, the Canadian Medical Association passed a resolution calling for removal of non-medical exemptions from vaccination-reporting policies. But it passed with only 58 per cent approval, and after a “heated debate.”

Parental right to not vaccinate?

Some claim that parents have a moral and legal right to choose whether to vaccinate. This right is often said to be safeguarded by the Canadian Charter of Rights and Freedoms. But that is far from certain.

Most people agree that parents require discretion to make decisions on their children’s behalf. Most also recognize, however, that state intervention is sometimes necessary to protect children’s interests. It is for this reason that blood transfusions can be required for minor children, even against the Charter rights of parents.

Despite this, there are reasons to question whether mandatory vaccination makes good policy sense. The unintended consequences of such policies suggest we should move cautiously.

What consequences?

One possible consequence is that some parents might remove children from schools rather than vaccinate, although in what kind of numbers is unknown. Indeed, some argue that mandatory vaccination violates children’s rights to an education for this reason. This argument is unconvincing. Whatever rights children have to access available education are outweighed by others’ rights not to be exposed to potentially fatal health risks.

Nonetheless, the removal of children is a double-edged sword. While remaining children would clearly benefit, those removed would remain unvaccinated — which does not serve their interests. These unvaccinated children would also still go to the park, to the shopping centre, to swimming lessons etc.

That could result in ever more coercive measures, such as the ban on unvaccinated minors entering public spaces — including synagogues, churches, schools, restaurants, stores and public transit — that was implemented in New York’s Rockland County in March 2019. It could include criminal sanctions for failing to follow a recommended vaccination schedule.

Another possible consequence is the emboldening of the small but vocal anti-vaccination movement, and greater entrenchment of anti-vaccine views. Entrenchment of anti-vaccine sentiment would make coercive measures both increasingly necessary and more difficult to implement; it is unclear whether the public has the appetite for that.

Are there ways to increase vaccination rates that avoid these consequences? Maybe.

Some non-coercive measures can address these other causes. For example, targeted information campaigns, early intervention, diversification of vaccine delivery, automatic reminders and targeted follow-up are all positively associated with vaccine uptake.

We should not be naïve about the health risks posed by undervaccination, or the impossibility of converting hard-core anti-vaxxers with appeals to evidence.

In particular, non-coercive measures might prove insufficient to reduce clustering. Some schools, for example, exhibit exceptionally low vaccination coverage. And there is reason to believe that hard-core opponents of vaccination are attracted to such schools. In which case, more coercive measures may become necessary.

But when it comes to such measures, we should proceed carefully. Not because of the fiction that such measures violate parents’ rights or children’s rights to an education. Vaccination is in the public interest, including that of individual children, which the state has a duty to protect.

Rather, it’s because of the potential drawbacks of attempting to force people to vaccinate their children. Mandatory vaccination should not be viewed as off the table, but we might first turn to the aforementioned non-coercive measures that are presently under-utilized.

We welcome your feedback and encourage you to share your thoughts. We ask that you be respectful of others and their points of view, refrain from personal attacks and stay on topic. To learn about our commenting policies and how we moderate, please read our Community Guidelines.